Provider Demographics
NPI:1033705553
Name:EDGELL FOSTER HOME
Entity Type:Organization
Organization Name:EDGELL FOSTER HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-465-5980
Mailing Address - Street 1:5393 SECREST RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-8647
Mailing Address - Country:US
Mailing Address - Phone:330-465-5980
Mailing Address - Fax:
Practice Address - Street 1:5393 SECREST RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-8647
Practice Address - Country:US
Practice Address - Phone:330-465-5980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle